9 Initially Worked Primarily for Government Funded Legal Services Programs Ensured that States Were Fair in the Administration of Medicare and Medicaid Continually Increasing Need for Age Related Services

10 ELDERLY POPULATION IN GENERAL HAS INCREASED COMPLICATIONS OF ACCESSING MEDICAID HIGH COST OF NURSING HOME CARE LACK OF ACCESS TO LONG-TERM HEALTH CARE

13 Texas Passed an Estate Recovery Law Repealed in 1989 Without Being Implemented OBRA Requires States to Implement a Basic Estate Recovery Program Estate Recovery Mandated House Bill 2292 Enabling Statute for Estate Recovery in Texas MERP Became Effective March 1, 2005

15 NAELA 1988 NATIONAL ACADEMY OF ELDER LAW ATTORNEYS Has grown to over 4,000 attorneys dedicated to assisting elderly people with an array of legal needs Texas NAELA 1990 TEXAS Chapter of the NATIONAL ACADEMY OF ELDER LAW ATTORNEYS State organizations aligned and began to develop DELAA 1991 DISABILITY AND ELDER LAW ATTORNEYS ASSOCIATION Developed by attorneys seeking greater knowledge and accountability in the assistance of the elderly and disabled

28 Solves only income problems Must be irrevocable Holds only grantor s income Distributions must be for certain purposes State has right of reimbursement All of a single source of income goes into trust Affects eligibility but not applied income Copyright 2011, Wright Abshire

31 The purpose is to prevent impoverishment of the community spouse when the other spouse enters a nursing home. Copyright 2011, Wright Abshire

32 Equals half of the couple s combined assets as of month of entry to medical care facility for a continuous stay (30 consecutive days), but Not less than $21,912 (in 2011) Not more than $109,560 (in 2011) Minimum SPRA in 2012: $22,728 Maximum SPRA in 2012: $113,640 Copyright 2011, Wright Abshire

33 If combined assets total $250,000, the SPRA is $109,560 If combined assets total $100,000, the SPRA is $50,000 If combined assets total $20,000, the SPRA is $21,912 Copyright 2011, Wright Abshire

34 This amount is $2, per month in This amount will increase to $2, in Copyright 2011, Wright Abshire

35 May be expanded (even beyond the $109,560 maximum) in certain instances to bring the community spouse s monthly income up to the MMMNA ($2,739.00). Copyright 2011, Wright Abshire

36 OBRA 1993 imposes a penalty (period of ineligibility) for disposing of assets for less than FMV. The length of the penalty period depends upon the amount transferred. Copyright 2011, Wright Abshire

37 No penalty if transferred to - The spouse The individual s child under 21 The individual s disabled child of any age A sibling with an equity interest who lived there 1 yr. before nursing home entry The individual s child who lived there 2 yrs. before nursing home entry and who provided care that delayed that event Copyright 2011, Wright Abshire

38 No penalty for assets transferred to - The spouse To the individual s disabled child of any age, or to a trust for the sole benefit of such child To a trust for the sole benefit of any disabled individual under 65 Copyright 2011, Wright Abshire

40 Look-Back Period - 60 months for all transfers. Penalty Period Begins - When the individual enters a nursing home, applies for Medicaid, and would be eligible but for the transfer. Copyright 2011, Wright Abshire

47 But I can gift $10,000 a year, right? (IRS/MDC/VA) We have too much in the way of assets to get Medicaid. I have $100,000 in the bank and need a Miller Trust. I can t qualify my husband for income eligibility because our combined social security is $2,023 a month.

48 Three words you should never say, just spend down. Never, ever say these five words, there s nothing you can do. You had to do something three years ago. You had to do something five years ago. Just transfer all your assets to the children, then apply. Just put the house in an RLT, then apply. Just disclaim the inheritance, then apply.

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